High-Frequency Oscillatory Ventilation as a Rescue Mode for Refractory Hypercarbia in Children

High-frequency oscillatory ventilation (HFOV) use in the airway obstructive status can be relatively contraindicated by the risk of air trapping leading to hemodynamic compromise. We experienced three young patients, a 7-month preterm male with respiratory syncytial virus (RSV) bronchiolitis complicated by secondary Streptococcal pneumonia, an 11-month male with Moraxella catarrhalis pneumonia and a 2-month male with RSV bronchiolitis complicated by Moraxella catarrhalis pneumonia. Those three cases developed hypercarbia from suspected airway obstruction which was refractory to pharmacological therapy and conventional mechanical ventilation (CMV). We utilized HFOV and achieved improvement in respiratory acidosis. All three cases had lower PaCO2 level after 6 hours of HFOV initiation and successfully transitioned back to CMV. The CO2 clearance in HFOV may be achieved from the combination of airway stenting effect from the higher mean airway pressure of HFOV and the other gas exchange mechanisms that is unique to HFOV such as pendelluft. These three cases shows that HFOV may be considered as a rescue treatment in children who have hypercarbia with airway obstruction which is refractory to pharmacological therapy and CMV.